Is poor performance on recognition memory effort measures indicative of generalized poor performance on neuropsychological tests?

Abstract

The detection of suboptimal effort has become crucial in clinical neuropsychological practice in order to make accurate diagnoses, prognoses, and referrals. Symptom Validity Testing (SVT) has been the most commonly utilized model for assessing effort, and frequently includes recognition memory tasks. Some conflicting views on this model purport, however, that measures of effort gathered from a recognition memory paradigm do not necessarily extend to effort in other cognitive domains and other areas of performance. The present study sought to investigate whether performance on an SVT measure, which utilizes recognition memory, the TOMM, could predict performance on other measures that do not evaluate recognition memory or just memory per se in a group of mildly traumatic brain-injured litigants. Results indicated that poor performance on the TOMM was significantly correlated with poorer performance on the WAIS-R and the HRNB-A. Further, experimental exploration of these results indicated that the overall neuropsychological performance of litigants with suboptimal effort was poorer than what is generally expected from mild TBI individuals, and was also lower than the other mild TBI examinees in the study, who were not classified by the TOMM as exhibiting suboptimal effort. These findings support the proposition that poor effort as measured by recognition memory effort measures is not restricted to recognition and memory measures. In fact, in the present study it appears that a poor performance on the TOMM is predictive of a generalized poorer performance on standardized measures such as the WAIS-R and the HNRB-A.

The implications of symptom validity test failure for ability-based test performance in a pediatric sample.

“…Effect sizes were large across most standardized tests, comparable to those seen in similar studies of adults, including samples with financial incentive to perform pooriy (Constantinou et al, 2005;Lange et al, 2010). The largest effects in this clinical sample were apparent on the WASI Matrix Reasoning subtest, CVLT-C, WISC-IV Digit Span subtest, and Grooved Pegboard.…”

Symptom Exaggeration by College Adults in Attention-Deficit Hyperactivity Disorder and Learning Disorder Assessments

“…As a preliminary indication, it appears reasonable that the base rate for symptom exaggeration among college students self-referred for ADHD evaluations might be estimated at approximately 25-48%, with a possible gender-by-evaluation-type interaction. This estimate is comparable to the 25% figure offered by Binder (1992) as a general base rate for symptom exaggeration in neuropsychological assessments, as well as the 30% rate found by Constantinou, Bauer, Ashendorf, Fisher, and McCaffrey (2005) when examining other populations. However, as our samples were small, our results should be considered only preliminary.…”

“…Failure on SVTs that use a recognition memory paradigm, like the WMT does, predicts lower scores on standardized intellectual and neuropsychological measures (Constantinou, Bauer, Ashendorf, Fisher, & McCaffrey, 2005). In fact, effort as measured by the WMT has been shown in other investigations to account for approximately 50% of the variance in a composite score from 43 different neuropsychological tests scores in patients across mixed diagnoses (Green, Rohling, Lees-Haley, & Allen, 2001).…”

Cognitive performance after Mild Traumatic Brain Injury: The impact of poor effort on test results and its relation to distress, personality and litigation

“…In these studies, poor effort is often regarded within the framework of 'malingering', a popular concept to describe patients that intentionally exert insufficient effort during testing or fake cognitive dysfunction in order to get some external incentive. Results of these studies show that poor effort is a major contributor to poor neuropsychological test performance [18][19][20][21]. Outside the mediolegal context, effort tests are rarely used, implicitly assuming that effort level will be adequate if no external gain is expected.…”